腹内压监测在外科急腹症及危重患者的临床观察和应用.doc

腹内压监测在腹腔间隔室综合征的临床观察和应用 温治强 宋越 李嘉 肖胜兵 （广东省梅州市人民医院普外一科，广东 梅州 514000） 摘要：目的 研究检测腹内压在危重病患者监测和治疗中的临床价值Abdomen cavity pressure monitoring observed and applied in abdominal comparment syndrome WEN Zhi-qiang，SONG Yue, LI Jia, XIAO Sheng-bing （The First Department of General Surgery, Meizhou People’s Hospital, Guangdong Meizhou 514000） 【Abstract】 Objective: To investigate and test the changes of intra-abdominal pressure(IAP)and its clinical significance of patients in ICU．Methods： continuously monitoring abdomen pressure of postoperative patients ; analysing the effects on respiratory function, hemodynamics and renal function caused by the increase of abdomen cavity pressure and carrying out symptomatic treatment. Results: In 46 cases of ACS，15 cases were treated expectant treatment，14 cases received operation, 17cases received drainagr of abdomen. 33 cases were recovered; 7 cases died and 6 gave up taking treatments． Conclusion: For those critical patients with risk factors of high intra—abdominal pressure should monitor their abdomi—nal pressure changes as routine．To provide effective treatment and nursing care for them in time could prevent abdominal compartment syndrome from either happening or developing and reduce death rate.． Key words：Significance of intra-abdominal pressure in evaluating condition and prognosis of critical patients 腹腔是一个密闭的腔室，正常情况下腹内压为零或接近零，当某些原因引起腹内压异常升高，并对人体各器官功能产生不良影响时，称为腹腔高压症(Intra—abdominal hypertension，IA H) [1] IAH导致各脏器功能障碍为腹腔间隔室综合征(Abdominal comparment syndrome，ACS)，以腹内高压，严重腹胀，呼吸窘迫，肾功能损害为主要特点。回顾2010年1月至2011年1月我院重症监护室收治的腹内压升高的外科危重患者，其中并发ACS 46例。参考有关文献，总结分析如下： 1临床资料 1.1 一般资料 本组46例 ，男24例，女21例 ，年龄 23～91岁，平 均年 龄 57岁。腹部严重外伤9例，头腹联合伤11例，腹部外科手术后10例，重症胰腺炎6例。大量腹水5例，严重烧伤2例，急性肠梗阻3例。慢性ACS 15例，急性ACS 29例。测得的患者IAP 20mmHg者为轻度升高12例，20-25mmHg 中度升高26例，≥25mmHg者为重度升高8例。 1.2 治疗方法46例患者均给予积极的液体复苏，维护器官功能和腹腔减压等治疗。15例单纯保守治疗，17例患者腹胀存在大量腹水在B超或CT定位穿剌管置引流减压，14例行开腹减压手术，其中术后切口行减张缝合8例，采用筋膜开放，聚丙烯网片覆盖暂时性“关腹”2例，腹腔镜灌洗减压4例。 1.3 结果 33例治愈，7例死亡，6例放弃治疗。死亡原因：3例合并多器官功能